尿路上皮癌是否有周圍神經侵犯可作為良好的預後預測因子

陳怡璇^1,2,3、李香瑩^2,3,、李經家³、柯宏龍³、李威明³、吳文正³、葉信志^2,3、

高雄醫學大學^１；高雄市立大同醫院 泌尿科^２；高雄醫學大學附設醫院 泌尿部^３；高雄醫學大學附設醫院 泌尿部^４

Perineural Invasion can Predict Prognosis for Upper Tract Urothelial Carcinoma Following Radical Nephroureterectomy

Yi-Hsuan Chen^1,2,3, Te-Wei Lin¹, Hsiang-Ying Lee^2,3,4, , Ching-Chia Li^3,4, Hung-Lung Ke^3,4, Wei-Ming Li ^3,4, Wen-Jeng Wu^3,4, Hsin-Chih Yeh^2,3,4

School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan¹;

Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan²;Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan³

Purpose: Taiwan has the highest incidence of upper tract urothelial carcinoma (UTUC) worldwide. Although many pathological factors can predict the prognosis of UTUC, previous studies have rarely discussed perineural invasion (PNI). Therefore, we aimed to investigate the effect of PNI on a well-established cohort of patients with UTUC.

Methods: This retrospective study included 803 patients with non-metastatic UTUC who underwent radical nephroureterectomy between June 2000 and August 2019. Demographic and clinicopathological parameters, including PNI, were collected for analysis. Using the Kaplan–Meier method and Cox proportional hazards model, we evaluated the significance of PNI with respect to

progression-free survival (PFS), cancer-specific survival(CSS), and overall survival (OS).

Results: The median follow-up was 30.9 months, and there were 83 cases of PNI (10.3%). PNI-positive patients had unfavorable pathological features, including high pT stage, positive lymph node involvement, high tumor grade, and more lymphovascular invasion (all p<0.001). Kaplan–Meier analysis showed that PNI was significantly associated with PFS, CSS, and OS (all p<0.00001), and when combined with lymphovascular invasion, patients could be divided into groups with distinct survival rates (all p\0.00001). In multivariate analysis, PNI was an independent factor leading to worse PFS (hazard ratio [HR]1.72, 95% confidence interval [CI] 1.19–2.50; p = 0.004), CSS (HR 2.54, 95% CI 1.58–4.10; p = 0.0001), and OS (HR 1.78, 95% CI 1.19–2.65; p = 0.005).

Conclusions: We demonstrated an association between PNI and the prognosis of UTUC. Routine assessment of PNI in UTUC with standardized protocols may help achieve better risk stratification and subject selection for perioperative treatment.